Pharmaceuticals in source separated sanitation systems: Fecal sludge and blackwater treatment

This study investigated, for the first time, the occurrence and fate of 29 multiple-class pharmaceuticals (PhACs) in two source separated sanitation systems based on: (i) batch experiments for the anaerobic digestion (AD) of fecal sludge under mesophilic (37 `C) and thermophilic (52 "C) conditions, and (ii) a full-scale blackwater treatment plant using wet composting and sanitation with urea addition. Results revealed high concentrations of PhACs in raw fecal sludge and blackwater samples, with concentrations up to hundreds of pg L-1 and fig kg-1 dry weight (dw) in liquid and solid fractions, respectively. For mesophilic and thermophilic treatments in the batch experiments, average PhACs removal rates of 31% and 45%, respectively, were observed. The average removal efficiency was slightly better for the full-scale blackwater treatment, with 49% average removal, and few compounds, such as atenolol, valsartan and hydrochlorothiazide, showed almost complete degradation. In the AD treatments, no significant differences were observed between mesophilic and thermophilic conditions. For the full-scale blackwater treatment, the aerobic wet composting step proved to be the most efficient in PhACs reduction, while urea addition had an almost negligible effect for most PhACs, except for citalopram, venlafaxine, oxazepam, valsartan and atorvastatin, for which minor reductions (on average 25%) were observed. Even though both treatment systems reduced initial PhACs loads considerably, significant PhAC concentrations remained in the treated effluents, indicating that fecal sludge and blackwater fertilizations could be a relevant vector for dissemination of PhACs into agricultural fields and thus the environment. (C) 2019 Elsevier B.V. All rights reserved

Fate of pharmaceuticals and pesticides in fly larvae composting

A novel and efficient organic waste management strategy currently gaining great attention is fly larvae composting. High resource recovery efficiency can be achieved in this closed-looped system, but pharmaceuticals and pesticides in waste could potentially accumulate in every loop of the treatment system and spread to the environment. This study evaluated the fate of three pharmaceuticals (carbamazepine, roxithromycin, trimethoprim) and two pesticides (azoxystrobin, propiconazole) in a fly larvae composting system and in a control treatment with no larvae. It was found that the half-life of all five substances was shorter in the fly larvae compost (<10% of control) and no bioaccumulation was detected in the larvae. Fly larvae composting could thus impede the spread of pharmaceuticals and pesticides into the environment

Repercusiones sanitarias de la calidad del agua: los residuos de medicamentos en el agua

This manuscript summarizes the main results obtained in various monitoring studies conducted in the Llobregat and the Ebro River basins to evaluate the occurrence of pharmaceuticals and drugs of abuse in their aquatic environments and the potentially derived risks for environmental and human health. The occurrence of these compounds in surface waters, located downstream the point of discharge of sewage treatment plants (STP), points out STPs effluents as the main source of these substances in the aquatic environment. Both river basins had similar pharmaceutical contamination patterns. However, hazard quotients (HQ) calculated for three different trophic levels (algae, daphnia and fish) pointed out sulfamethoxazol (sulfamide antibiotic) for algae, gemfibrozil (lipid regulator) for algae and fish, clofibric acid (lipid regulator) and erythromycine (macrolide antibiotic) for daphnia, and ibuprofen (analgesic anti-inflammatory) for all investigated tropic levels, as the compounds with the highest ecotoxicological risk in the Llobregat. In the Ebro River, the most problematic pharmaceuticals were sulfamethoxazol for algae, and erythromycine, clofibric acid and fluoxetine (anti-depressive) for daphnids. Levels of drugs of abuse measured in surface waters of the Ebro River were one and two orders of magnitude lower than those observed in effluent and influent sewage waters, respectively. Lack of data about their ecotoxicity does not allow calculation of HQ for these compounds. The presence of pharmaceuticals and drugs of abuse in surface and drinking waters is not subjected to regulation; hence, they are not considered priority pollutants to be included in monitoring programs. However, due to their possible harmful outcomes in wildlife, research on their potential effects in human health is indispensable.Este trabajo resume varios estudios de monitorización de fármacos y drogas de abuso llevados a cabo en el medio ambiente acuático de las cuencas de los ríos Llobregat y Ebro con el fin de evaluar la calidad del agua en relación a la presencia de estas substancias y su potencial riesgo para la salud ambiental y pública. La identificación de estos compuestos aguas abajo del punto de vertido de las plantas depuradoras apunta a la descarga de agua residual tratada como la principal fuente de emisión de estos contaminantes en el medio acuático. El perfil de contaminación por fármacos fue bastante similar en ambas cuencas. No obstante, los índices de riesgo (HQ) calculados para los fármacos en diferentes niveles tróficos (algas, dáfnidos y peces) indican que los compuestos que presentan un mayor riesgo ecotóxico en el Llobregat son el sulfametoxazol (antibiótico sulfamida) para las algas, el gemfibrozil (regulador de lípidos) para las algas y los peces, el ácido clofíbrico (regulador de lípidos) y la eritromicina (antibiótico macrólido) para los dáfnidos, y el ibuprofeno (analgésico anti-inflamatorio) para todos los eslabones tróficos. En el Ebro, los compuestos más problemáticos son el sulfametoxazol para las algas, y la eritromicina, el ácido clofíbrico y la fluoxetina (antidepresivo) para los dáfnidos.Los niveles de drogas de abuso (y sus metabolitos) determinados en la cuenca del Ebro son aproximadamente uno y dos órdenes de magnitud más bajos respectivamente que los determinados en las aguas de salida y de entrada a las depuradoras. Sin embargo, debido a la falta de datos sobre su ecotoxicidad, no se han podido calcular índices de riesgo.La presencia de estos compuestos (fármacos y drogas) en aguas superficiales y de bebida aun no está regulada y, por lo tanto, no constituyen parámetros de obligado control. Aún es imprescindible seguir investigando para poder evaluar su posible efecto en la salud humana

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription

Health implications of water quality: drugs residues in water Repercusiones sanitarias de la calidad del agua: los residuos de medicamentos en el agua

<div class="column"><p><span>This manuscript summarizes the main results obtained in various monitoring studies conducted in the Llobregat and the Ebro River basins to evaluate the occurrence of pharmaceuticals and drugs of abuse in their aquatic environments and the potentially derived risks for environmental and human health. The occurrence of these compounds in surface waters, located downstream the point of discharge of sewage treatment plants (STP), points out STPs effluents as the main source of these substances in the aquatic environment. </span></p> <p><span>Both river basins had similar pharmaceutical contamination patterns. However, hazard quotients (HQ) calculated for three different trophic levels (algae, daphnia and fish) pointed out sulfamethoxazol (sulfamide antibiotic) for algae, gemfibrozil (lipid regulator) for algae and fish, clofibric acid (lipid regulator) and erythromycine (macrolide antibiotic) for daphnia, </span>and ibuprofen (analgesic anti-inflammatory) for all investigated tropic levels, as the compounds with the highest ecotoxicological risk in the Llobregat. In the Ebro River, the most problematic pharmaceuticals were sulfamethoxazol for algae, and erythromycine, clofibric acid and fluoxetine (anti-depressive) for daphnids.</p> <p><span>Levels of drugs of abuse measured in surface waters of </span>the Ebro River were one and two orders of magnitude lower than those observed in effluent and influent sewage waters, respectively. Lack of data about their ecotoxicity does not allow calculation of HQ for these compounds.</p> <p><span>The presence of pharmaceuticals and drugs of abuse in surface and drinking waters is not subjected to regulation; hence, they are not considered priority pollutants to be included in monitoring programs. However, due to their possible harmful outcomes in wildlife, research on their potential effects in human health is indispensable.</span></p></div><br><div class="column"><p><span>Este trabajo resume varios estudios de monitorización de fármacos y drogas de abuso llevados a cabo en el medio ambiente acuático de las cuencas de los ríos Llobregat y Ebro con el fin de evaluar la calidad del agua en relación a la presencia de estas substancias y su potencial riesgo para la salud ambiental y pública. La identificación de estos compuestos aguas abajo del punto de vertido de las plantas depuradoras apunta a la descarga de agua residual tratada como la principal fuente de emisión de estos contaminantes en el medio acuático. </span></p> <p><span>El perfil de contaminación por fármacos fue bastante similar en ambas cuencas. No obstante, los índices de riesgo (HQ) calculados para los fármacos en diferentes niveles tróficos (algas, dáfnidos y peces) indican que los compuestos que presentan un mayor riesgo ecotóxico en el Llobregat son el sulfametoxazol (antibiótico sulfamida) para las algas, el gemfibrozil (regulador de lípidos) para las algas y los peces, el ácido clofíbrico (regulador de lípidos) y la eritromicina (antibiótico macrólido) para los dáfnidos, y el ibuprofeno (analgésico anti-inflamatorio) para todos los eslabones tróficos. En el Ebro, los compuestos más problemáticos son el sulfametoxazol para las algas, y la eritromicina, el ácido clofíbrico y la fluoxetina (antidepresivo) para los dáfnidos.</span></p><p>Los niveles de drogas de abuso (y sus metabolitos) determinados en la cuenca del Ebro son aproximadamente uno y dos órdenes de magnitud más bajos respectivamente que los determinados en las aguas de salida y de entrada a las depuradoras. Sin embargo, debido a la falta de datos sobre su ecotoxicidad, no se han podido calcular índices de riesgo.</p><p>La presencia de estos compuestos (fármacos y drogas) en aguas superficiales y de bebida aun no está regulada y, por lo tanto, no constituyen parámetros de obligado control. Aún es imprescindible seguir investigando para poder evaluar su posible efecto en la salud humana.</p></div

Health implications of water quality: drugs residues in water

Este trabajo resume varios estudios de monitorización de fármacos y drogas de abuso llevados a cabo en el medio ambiente acuático de las cuencas de los ríos Llobregat y Ebro con el fin de evaluar la calidad del agua en relación a la presencia de estas substancias y su potencial riesgo para la salud ambiental y pública. La identificación de estos compuestos aguas abajo del punto de vertido de las plantas depuradoras apunta a la descarga de agua residual tratada como la principal fuente de emisión de estos contaminantes en el medio acuático. El perfil de contaminación por fármacos fue bastante similar en ambas cuencas. No obstante, los índices de riesgo (HQ) calculados para los fármacos en diferentes niveles tróficos (algas, dáfnidos y peces) indican que los compuestos que presentan un mayor riesgo ecotóxico en el Llobregat son el sulfametoxazol (antibiótico sulfamida) para las algas, el gemfibrozil (regulador de lípidos) para las algas y los peces, el ácido clofíbrico (regulador de lípidos) y la eritromicina (antibiótico macrólido) para los dáfnidos, y el ibuprofeno (analgésico anti-inflamatorio) para todos los eslabones tróficos. En el Ebro, los compuestos más problemáticos son el sulfametoxazol para las algas, y la eritromicina, el ácido clofíbrico y la fluoxetina (antidepresivo) para los dáfnidos.Los niveles de drogas de abuso (y sus metabolitos) determinados en la cuenca del Ebro son aproximadamente uno y dos órdenes de magnitud más bajos respectivamente que los determinados en las aguas de salida y de entrada a las depuradoras. Sin embargo, debido a la falta de datos sobre su ecotoxicidad, no se han podido calcular índices de riesgo.La presencia de estos compuestos (fármacos y drogas) en aguas superficiales y de bebida aun no está regulada y, por lo tanto, no constituyen parámetros de obligado control. Aún es imprescindible seguir investigando para poder evaluar su posible efecto en la salud humana.This manuscript summarizes the main results obtained in various monitoring studies conducted in the Llobregat and the Ebro River basins to evaluate the occurrence of pharmaceuticals and drugs of abuse in their aquatic environments and the potentially derived risks for environmental and human health. The occurrence of these compounds in surface waters, located downstream the point of discharge of sewage treatment plants (STP), points out STPs effluents as the main source of these substances in the aquatic environment. Both river basins had similar pharmaceutical contamination patterns. However, hazard quotients (HQ) calculated for three different trophic levels (algae, daphnia and fish) pointed out sulfamethoxazol (sulfamide antibiotic) for algae, gemfibrozil (lipid regulator) for algae and fish, clofibric acid (lipid regulator) and erythromycine (macrolide antibiotic) for daphnia, and ibuprofen (analgesic anti-inflammatory) for all investigated tropic levels, as the compounds with the highest ecotoxicological risk in the Llobregat. In the Ebro River, the most problematic pharmaceuticals were sulfamethoxazol for algae, and erythromycine, clofibric acid and fluoxetine (anti-depressive) for daphnids. Levels of drugs of abuse measured in surface waters of the Ebro River were one and two orders of magnitude lower than those observed in effluent and influent sewage waters, respectively. Lack of data about their ecotoxicity does not allow calculation of HQ for these compounds. The presence of pharmaceuticals and drugs of abuse in surface and drinking waters is not subjected to regulation; hence, they are not considered priority pollutants to be included in monitoring programs. However, due to their possible harmful outcomes in wildlife, research on their potential effects in human health is indispensable